Use of Everolimus in Liver Transplantation

Abstract

Immunosuppression after liver transplantation (LT) is presently based on use of calcineurin inhibitors (CNI), although they are associated with an increased incidence of renal dysfunction, cardiovascular complications, and de novo and recurrent malignancies. Over the past decade, mammalian target of rapamycin inhibitors have received considerable attention as immunosuppressants because they are associated with a more favorable renal profile versus CNI, as well as antiproliferative activity in clinical studies. Comprehensive guidelines on use of everolimus (EVR) in LT are still lacking. In Italy, a project, named Everolimus: the road to long-term functioning, was initiated to collect the experience on EVR after LT with the aim of providing guidance for transplant clinicians. Herein, recommendations by this national consensus group, based on Delphi methodology, are presented. Consensus was reached on 20 of the 23 statements proposed, and their level of evidence, grade of recommendation, and percent of agreement are reported. Statements are grouped into 4 areas: (A) renal function; (B) time of EVR introduction, CNI reduction and elimination, and risk for graft rejection; (C) antiproliferative effects of EVR; and (D) management of EVR-related adverse events. The high level of consensus shows that there is good agreement on the routine use of EVR in predefined clinical scenarios, especially in light of posttransplant nephrotoxicity and other adverse events associated with long-term administration of CNIs.

Everolimus in clinical practice after liver transplantation: a single-center experience

“…В феврале 2017 г. опубликованы совокупные дан-ные национальной рабочей группы из Италии [23], где определены основные положения по раннему назначению эверолимуса после трансплантации пе-чени и по конверсии в отдаленном периоде, соот-ветствующие принципам, которых придерживались и авторы настоящего исследования.…”

Refining diagnosis and management of chronic venous disease: Outcomes of a modified Delphi consensus process

“…The panellists were asked to anonymously express their level of agreement with each statement, using a 5-point Likert scale (1 = disagree; 2 = somewhat disagree; 3 = neither agree nor disagree; 4 = somewhat agree; 5 = agree). The use of a 5-point Likert Scale with this consensus threshold was defined a priori as described in previous studies with this modified process [29,[31][32][33][34]. Consensus was considered if either the sum of answers 1 and 2 (negative agreement), or 4 and 5 (positive agreement) exceeded 70%, as described in previous studies with this method [29,32,33,35].…”

Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) for Peritoneal Metastases in Solid Organ Graft Recipients: First Experience

“…Use of modern immunosuppressive agents has allowed to reduce acute rejection incidence and to prolong graft survival in solid organ transplant recipients. However, the comorbidities caused by immunosuppression remain an ongoing challenge [1]. A particular problem is the increased risk of developing secondary malignancies after solid organ transplantation [2], with a reported prevalence between 4% and 18% or an average incidence of 6% [3].…”